Background: Issues faced by metis, male-to-female (MtF) transgender
people, in Nepal are relatively understudied. Although a few qualitative
studies have documented the stigma and discrimination faced by metis, limited
published evidence is available on the extent of the stigma, discrimination and
violence experienced by metis. This study aimed to address this gap.Methods: We
conducted a cross-sectional survey among a convenient sample of 120 meti-identified
transgender people in urban locations (Kathmandu and Pokhara) in Nepal,
recruited through a community-based organisation, Blue Diamond Society. We
measured the nature and extent of stigma, discrimination, and violence from
various perpetrators; and access to HIV services; and presence and degree of
depression. Univariate and bivariate analyses were conducted.Results: Participants'' mean age was 27.2 years. About
two-fifths (42%) of the participants reported to be in part- or full-time sex
work. High prevalence of different forms of discrimination was observed. The
percentage of participants who reported experiencing physical abuse, verbal
abuse, blackmailing and threat at least once a month were 21%, 16%, 27% and 24%,
respectively. More than half (58%) reported having been discriminated against by health care
providers. Almost all of the
participants (98%) who were tested for HIV the last time had tested themselves
in the clinic of a community-based agency, and not in public hospitals. Seven
percent self-reported as HIV positive. Moderate or severe depression was
reported by 28.3%. Bivariate analysis revealed statistically significant association physical
abuse and depression.Conclusions: In
spite of the progressive legal recognition of ''third gender'' identity for metis
in Nepal, high prevalence of various forms of discrimination from diverse
perpetrators were found. Systematic efforts are needed to sensitise and train
health care providers in public health settings and police personnel to accept
metis and to equip them to provide non-discriminatory and optimal care. Mental
health issues need to be addressed, and support needs to be extended for
victims of physical and sexual violence. Long-term solution may exist in
changing the negative attitudes among the general public by promoting better understanding
of sexual minorities.